Where Telehealth Fails to Address Psychiatrist Shortage, Collaborative Care Can Help

Telehealth is often lauded as the answer to a common problem plaguing many sectors within the health care industry: a shortage of qualified workers. That’s especially true in behavioral health care, where treatment doesn’t always require a physical examination.

In fact, behavioral health care often dominates the telemedicine field. Take Michigan, for example: NPR reported that behavioral health services accounted for 65% of all telehealth claims within the state’s Medicaid program in 2016.

Such services are especially useful in rural areas, which often lack behavioral health providers altogether.

“There are workforce shortages nationwide right now, but in rural America, it’s exacerbated,” Max Isaacoff, government affairs and policy manager at the National Rural Health Association, said during a recent conference panel on telehealth. “Telemedicine has really given them the lifeline to still receive [care].

But despite the opportunities telehealth presents, it doesn’t get to the heart of the real problem, some providers argue. To better address the behavioral health worker shortage, they believe behavioral health operators and primary care facilities should also be leaning into collaborative care.

“There are only so many of us at the end of the day, no matter where you put us,” Liberty Eberly, chief medical officer at InnovaTel Telepsychiatry, said during the same telehealth panel. “If we could really move forward collaborative care models, … I think we’re really going to further solve that access issue.”

Both Isaacoff and Eberly’s comments came last month during the Payer’s Behavioral Health Management and Policy Summit in Washington, D.C. The event was hosted by World Congress, a provider of global health care conferences, and the Association for Behavioral Health and Wellness (ABHW), a national group representing behavioral health payers.

Collaborative care opportunities

While collaborative care has many definitions, it’s generally characterized as a type of integrated care that breaks down silos and focuses on holistic treatment of patients by combining behavioral and physical health care.

For example, a primary care physician consulting with a psychiatrist about how to treat their patients suffering from mental health conditions could be one form of collaborative care.

InnovaTel Telepsychiatry, a nationwide network of behavioral health professionals who use telehealth to help providers treat patients, is doing just that, Eberly said. 

“It’s going to take me at least an hour to do a full psychiatric evaluation and make recommendations versus collaborating with a primary care physician who can bring to me their most complicated cases,” she said. “I can give them suggestions for probably four, six [or] eight patients, maybe at most, over the course of an hour [when] I could only see one if they were to send them to me.”

The arrangement allows the behavioral health needs of more patients to be addressed. That’s unlike telehealth, which simply redistributes psychiatrists, allowing different — but not more — patients to be treated. However, primary care physicians can use telehealth to consult psychiatrists.

In addition to the aforementioned curbside consultation, Eberly told attendees that co-located models where psychiatrists are put in physician’s offices are also viable collaborative care options.

However, reimbursement can be a problem for both collaborative care models.

“There are codes, but my experience has been that it’s very cumbersome to use that system,” Eberly said. “There are very specific requirements, you have to use a very specific type of registry and it’s not very conducive to the practitioners … or the psychiatrists that are using those models.”

For InnovaTel and the primary care physicians it works with, that has meant finding different ways to bridge the gap, Eberly said.

“A lot of times these facilities are block purchasing an hour of psychiatric time or two hours of psychiatric time a week that they’re paying out of pocket to have these services,” she said. “The collaborative care I’m doing now these agencies are just paying for an hour of my time, they’re not being getting reimbursed for that, unfortunately.”